Communication Practices of Many US Physicians May Be Discouraging HPV Vaccination

HPV vaccination may be discussed with parents in ways likely to discourage them from vaccinating.

In a national sample, many pediatricians and primary care physicians reported communicating about HPV vaccination with parents in ways that likely discourage them from having their children vaccinated. These findings were published in Cancer Epidemiology, Biomarkers & Prevention (2015; doi:10.1158/1055-9965.EPI-15-0879).

The research was led by Melissa B. Gilkey, PhD, assistant professor of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, Massachusetts.

Gilkey noted that although HPV vaccination is an effective, safe, and easy way to prevent certain cancers and other conditions, very few US adolescents are vaccinated in a timely manner. Prior research has shown that a health care provider's recommendation is the single biggest influence on whether parents decide to allow HPV vaccination of their adolescents. Given their influence, understanding how providers communicate about HPV vaccination is critical for getting more adolescents to receive the vaccine, she explained.

Gilkey and colleagues, including senior author Noel Brewer, PhD, associate professor of health behavior at the University of North Carolina, conducted a national online survey of US pediatricians and family physicians in 2014, in which they measured 5 indicators of HPV vaccine recommendation quality.

These indicators included 2 for timeliness (recommend vaccination by age 11 to 12 years vs older or not at all, for girls and for boys), and 1 each for consistency (recommend for all vs those considered to be at risk), urgency (recommend same-day vaccination vs otherwise), and strength of endorsement (saying that the vaccine is very or extremely important vs less so).

The study included 776 physicians; 68% were male, and 55% were in practice for 20 years or longer.

Gilkey and colleagues found that 27% of physicians across the country reported that they do not strongly endorse HPV vaccination, and 26% and 39% reported that they do not provide timely recommendations for vaccinating girls and boys, respectively.

Approximately 59% of the physicians recommended HPV vaccination more often for adolescents who they perceived to be at higher risk for getting an HPV infection, as opposed to recommending it routinely for all adolescents. Only 51% of physicians recommended same-day vaccination at the time of visit.

The researchers found that the quality of recommendation was higher among physicians who began the discussion by saying the child is due for vaccination rather than giving parents information about vaccination or asking them if they had questions about vaccination. Recommendation quality was lower among physicians who were uncomfortable with discussing sexually transmitted infections or who believed that parents thought HPV vaccination was not important.

In an interview, Gilkey said, "The main purpose of our study was to assess how physicians recommend HPV vaccination. Specifically, we wanted to know how often pediatricians and family physicians use 5 communication practices that are necessary for delivering the vaccine according to national guidelines.

"We were surprised that physicians so often reported recommending HPV vaccination inconsistently, behind schedule, or without urgency. Of the 5 communication practices we assessed, about half of physicians reported 2 or more practices that likely discourage timely HPV vaccination," Gilkey said. "We are currently missing many opportunities to protect today's young people from future HPV-related cancers. Helping providers communicate about the HPV vaccine effectively is a promising strategy for getting more adolescents vaccinated.”